Hospital Damas

Alcançado o Século XXI, os povos indígenas latino-americanos continuam a ser fustigados e surrupiados. Esta pesquisa, se embasará pelo seguinte problema: A Corte IDH leva em consideração as premissas da plurinacionalidade no Caso Povo Xukuru vs. Brasil? Buscou-se através de pesquisa empírica quali-quanti, aferir a sensibilidade dialógica deste organismo jurisdicional à diversidade territorial vivenciada historicamente pelos povos originários estudados. Para tanto, submeteu-se à análise, o Caso Povo Xukuru vs. Brasil, pela testagem dos traços de plurinacionalidade. Convém saber se considera como critério decisório aspectos como abertura dialógica, visão de mundo indígena, ancestralidade, espiritualidade, bem como se incorpora em seu raciocínio jurisprudencial as amplas concepções de propriedade e territorialidade ali verificadas. Angariando pontuação a cada testagem de traço, foi possível através de análise gráfica quantificar o desempenho da Corte. Da leitura dos dados, concluiu-se que a Corte IDH, ainda não está satisfatoriamente aberta ao pluralismo epistemológico da rica diversidade étnico-cultural continental.

Background: Major Depressive Disorder (MDD) is a highly prevalent condition that frequently co-occurs with chronic medical illnesses, creating a synergistic burden that worsens quality of life, impairs treatment adherence, and increases mortality. The relationship is bidirectional, with medical illness increasing depression risk and depression contributing to the onset and progression of somatic disease. Aim: This article aims to review the multidisciplinary management of depression in medically ill patients, integrating psychological, pharmacological, nursing, social, and digital health approaches to improve detection and treatment outcomes. Methods: The review synthesizes epidemiological data, pathophysiological mechanisms (including shared genetics, inflammation, and neurobiological pathways), and evidence from clinical trials and meta-analyses. It evaluates diagnostic challenges, screening tools, and a range of management strategies, including pharmacotherapy (with attention to drug-disease interactions), psychotherapy, neuromodulation, and collaborative care models. Results: Depression is prevalent across chronic conditions like cancer, cardiovascular disease, and diabetes, with rates often exceeding 20%. Effective management requires an integrated, etiology-driven approach. Antidepressants and adapted psychotherapies demonstrate efficacy, but success depends on careful agent selection to avoid adverse interactions. Collaborative care models, which systematize screening and combine a care manager with psychiatric oversight, consistently yield the best functional and symptomatic outcomes. Conclusion: A multifaceted, patient-centered strategy that coordinates medical and mental healthcare is essential. Success hinges on moving beyond simple screening to embed management within a structured, multidisciplinary framework that addresses the complex biological, psychological, and social interplay between depression and physical illness.

Abstract Introduction: In the early post-operative period, pulmonary complications remain an important factor of increased morbidity and mortality. Several symptoms have been reported that warrant special attention, a common one being dyspnea. Dyspnea can be attributed to several causes including atelectasis, pleural effusions and pneumonia. Atelectasis is the most common cause and is usually ascribed to general anesthesia effects. Case Discussion: This is a case of a 71-year-old man with past medical history of severe coronary artery disease, that was consulted to our services status post coronary artery bypass graft surgery (CABG) due to dyspnea. Patient had CABG a day prior to consult and was extubated the same day but developed dyspnea afterwards. Patient did not have history of dysphagia and 2D echocardiogram done prior to surgical procedure reveal an ejection fraction above 55%, which is considered normal. Chest x-ray was done to further evaluate for pleural effusions or any other complications and was found with left lower lobe atelectasis. Mucus plug was suspected as culprit of findings and was managed with oropharyngeal suctioning and saline. Since patient continued with dyspnea, pneumology services were consulted and bronchoscopy was performed. During procedure, it was noted that the left main stem bronchus was occluded with thick mucus, that was suctioned and irrigated with saline, and a white round foreign object was also found to be occluding distally. Several attempts to extract object were made, and after it was done successfully, the mucosa was noted with erythema and edema. Once extracted, object disintegrated revealing a coated aspirin. Discussion: Foreign bodies in the airways can be life-threatening, specially if not recognized early. Cardiac surgery patients may be at higher risk due to a variety of factors, one of them being general anesthesia impairing cough reflex and mucociliary clearance. Although incentive spirometry, head of bed elevation and early ambulation after cardiac surgery are important tools implemented to prevent atelectasis and aspiration post-surgery, medical team must be aware that patients are still at increased risk for this type of event. Aspirin, which is part of the medications given for coronary artery disease, can cause bronchoconstriction, airway inflammation, erosion, post-obstructive pneumonia, acute respiratory distress syndrome, and eventually may lead to death. Therefore, it is critical to have aspiration high in the differential of patients with post-surgery dyspnea so that they can be treated accordingly and prevent serious complications.

To evaluate the risk of hyponatremia during therapy with antidepressant drugs, in particular by investigating whether there is a different risk profile depending on the class or single active principles. A meta-analysis was performed including all studies in which the risk of hyponatremia in subjects with or without antidepressant treatment was assessed. An extensive Medline, Embase and Cochrane search was performed, to retrieve all studies published up to February 5th 2024, using the following words: hyponatremia and antidepressant. Of 409 retrieved articles, 10 studies satisfied the inclusion criteria encompassing a total of 1,026,870 patients with 89,403 hyponatremic subjects. Treatments with selective serotonin reuptake inhibitors (OR = 3.31 [2.41;4.56], p < 0.01), serotonin-noradrenaline reuptake inhibitors (OR = 5.79 [1.27;26.49], p = 0.02) and tricyclic antidepressants (OR = 3.01 [1.27;7.14], p = 0.01) were found to be significantly associated with an increased risk of hyponatremia, whereas treatment with noradrenaline and specific serotonergic antidepressants was not. A network meta-analysis indicated that treatments with venlafaxine (OR = 5.99 [2.39;14.99], p < 0.01), paroxetine (OR = 4.93 [2.01;12.12], p < 0.01), sertraline (OR = 4.15 [1.98;8.70], p < 0.01), citalopram (OR = 3.49 [1.54;7.9], p < 0.01), escitalopram (OR = 3.49 [1.49;8.19], p < 0.01), fluoxetine (OR = 3.40 [1.13;10.21], p = 0.03) and mirtazapine (OR = 2.83 [1.16;6.92], p = 0.02) were found to be significantly associated with an increased risk of hyponatremia with a progressively decreasing OR. Clomipramine (OR = 4.50 [0.97;20.93], p = 0.05) also showed a trend towards a greater risk of hyponatremia. Otherwise, treatments with fluvoxamine, imipramine, maprotiline, amitriptyline and mianserin were not associated with an increased risk of hyponatremia. These data appear useful on clinical grounds, in order to increase the awareness regarding the possibility that antidepressants induce hyponatremia and to encourage regular serum sodium monitoring.

This thesis investigates the challenges of micromanagement for software developers working remotely, especially after the spread of COVID-19. While remote work offers flexibility, excessive control by managers can lead to demotivation, reduced productivity, and decreased creativity. The study uses a mixed-methods approach, combining surveys and interviews with developers and managers to understand their perspectives on micromanagement. The results show that this practice negatively impacts autonomy, increases stress, and affects the quality of work delivered, highlighting the need for more balanced management strategies. &nbsp;

Background: Health security is critical for protecting populations from health threats such as infectious diseases and public health emergencies. Training and health education are proactive strategies that enhance individual and community resilience, strengthen health systems, and improve preparedness for crises. This study examines the impact of structured training and health education interventions on improving health security outcomes. Methods: A quasi-experimental design with pre-test/post-test assessments was employed. The study involved 100 participants recruited through convenience sampling from a community health center setting. The intervention consisted of an eight-session program delivered over four weeks, covering topics such as hygiene, infection control, emergency preparedness, and vaccination awareness. Data were collected using validated questionnaires and focus group discussions, with quantitative analysis performed using SPSS and qualitative data analyzed thematically. Results: Post-intervention results showed significant improvements in knowledge, attitudes, and practices related to health security. High knowledge levels increased from 18.3% to 74.2%, positive attitudes rose from 26.7% to 80%, and good practices improved from 18.3% to 66.7%. Paired sample t-tests confirmed statistically significant gains across all domains (p &lt; 0.001). Qualitative feedback highlighted enhanced engagement and confidence among participants.Conclusion: The study demonstrates that targeted training and health education interventions effectively improve health security by enhancing knowledge, attitudes, and practices. These findings underscore the importance of integrating such programs into health systems to build resilient communities capable of addressing public health emergencies.

BackgroundEncephalocele refers to protrusion of the meninges and brain tissue through a skull bone defect. It results from congenital, traumatic, neoplastic, or spontaneous reasons. Traumatic encephalocele occurs because of the posttraumatic fracture of the skull bone or iatrogenic causes. The manifestations vary a lot, such as rhinorrhea, seizures, headaches, and focal neurological deficits.Case presentationA 20-year-old Syrian male presented to our department with the complaint of clear cerebrospinal fluid drainage from his right nostril, which started 6 years ago after a head trauma, moderate headache, and episodes of tonic–clonic seizures without any response to medical treatment. Then, 2 months ago, the patient had meningoencephalitis, so he was admitted to the intensive care unit and treated for a month until he was cured. The patient underwent radiological investigations, which showed that he had a base fracture with an encephalocele in the nasal cavity. The brain tissues with the meninges herniated through the skull base fracture with a significant expansion of the subarachnoid spaces in the right hemisphere. He was advised to undergo surgical repair at that time, but he refused the surgery. During this visit, surgery was indicated. The surgery was done by a specialist who returned the herniated brain tissues to their normal location, repaired the meninges, and reconstructed the skull base with bone cement and bio-glue. The patient’s recovery after the surgery was uneventful.ConclusionTraumatic encephalocele is a rare and unexpected complication of trauma, but we should keep it in mind when the patient comes with head trauma because of its life-threatening consequences. This complication can happen after years of trauma if the patient refuses treatment, therefore, we must educate patients about the dangerous results of neglecting cerebrospinal fluid leakage and skull fractures.

Congenital insensitivity to pain (CIP) is a rare condition where individuals are born with an inability to perceive pain. This can lead to various complications in the skin, skeletal system, and other bodily systems. Chronic osteomyelitis is one of the possible manifestations of CIP, which can be difficult to diagnose and treat due to the lack of pain as a diagnostic criterion. A 5-year-old boy with CIP developed chronic osteomyelitis in his right leg, presented with fever, claudication, swelling, and local heat for 2 months. He had a history of CIP since birth, diagnosed at 18 months of age. He also had a family history of CIP. He had previously suffered a shoulder fracture and had taken asthma medication for 1 year. He had experienced tonsillitis 2 months ago. On examination, he had hepatomegaly, enlarged lymph nodes in the groin, and a minor swelling on the right knee. He had an audible snapping sound during knee flexion. Blood tests showed increased inflammatory markers. Imaging studies confirmed presence of osteomyelitis, and bone biopsy revealed infection with Staphylococcus aureus. Treatment included vancomycin and cefotaxime. Genetic factors behind CIP were discussed, highlighting challenges in diagnosis. Manifestations of CIP, diverse and age-related, include orthopaedic issues, ophthalmological effects, and thermoregulation disturbances. The patient's case is presented with unique features, necessitating a comprehensive diagnostic approach. This case highlights the challenges faced in diagnosing osteomyelitis among CIP patients and emphasizes the need for other diagnostic criteria apart from pain.

Este artigo apresenta uma nova abordagem baseada em Rede Neural Convolucional Bidimensional (Convolutional Neural Network CNN) e Gráfico de Recorrência (Recurrence Plot RP) para previsão em curto prazo da geração de energia elétrica de uma microusina fotovoltaica conectada à rede elétrica, localizada no Centro de Excelência em Eficiência Energética da Amazônia - CEAMAZON, da Universidade Federal do Pará (UFPA). O gráfico de recorrência foi utilizado para transformação das séries temporais em imagens para serem utilizadas como entrada para a CNN. A previsão de geração de energia elétrica com maior precisão possibilita ao usuário conhecer com maior grau de acerto quais os possíveis custos para implantação da rede e os prazos para retorno financeiro, além de avaliar com maior assertividade a disponibilidade de carga que poderá ser conectada ao sistema. Os resultados da previsão com a utilização da CNN 2D e RP foram comparados com resultados utilizando outros tipos de rede neurais já consolidadas na área, tendo obtido valores RMSE satisfatórios, da ordem de 1,85% menor que o erro obtido com a Perceptron Multicamadas e 3,03% menor que o RMSE da CNN 1D, mostrando assim a sua aplicabilidade para o problema.